Abstract
The global health community has recognized that expanding the contraceptive method mix is a programmatic imperative since (1) one-third of unintended pregnancies are due to method failure or discontinuation, and (2) the addition of a new method to the existing mix tends to increase total contraceptive use. Since July 2011, CARE has been implementing the Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) initiative to increase the availability, quality, and use of contraception, with a particular focus on highly effective and long-acting reversible methods-intrauterine devices (IUDs) and implants-in crisis-affected settings in Chad and the Democratic Republic of the Congo (DRC). This initiative supports government health systems at primary and referral levels to provide a wide range of contraceptive services to people affected by conflict and/or displacement. Before the initiative, long-acting reversible methods were either unknown or unavailable in the intervention areas. However, as soon as trained providers were in place, we noted a dramatic and sustained increase in new users of all contraceptive methods, especially implants, with total new clients reaching 82,855, or 32% of the estimated number of women of reproductive age in the respective catchment areas in both countries, at the end of the fourth year. Demand for implants was very strong in the first 6 months after provider training. During this time, implants consistently accounted for more than 50% of the method mix, reaching as high as 89% in Chad and 74% in DRC. To ensure that all clients were getting the contraceptive method of their choice, we conducted a series of discussions and sought feedback from different stakeholders in order to modify program strategies. Key program modifications included more focused communication in mass media, community, and interpersonal channels about the benefits of IUDs while reinforcing the wide range of methods available and refresher training for providers on how to insert IUDs to strengthen their competence and confidence. Over time, we noted a gradual redistribution of the method mix in parallel with vigorous continued family planning uptake. This experience suggests that analyzing method mix can be helpful for designing program strategies and that expanding method choice can accelerate satisfying demand, especially in environments with high unmet need for contraception.
Highlights
That there are 225 million women who want to avoid pregnancy but are not currently using a contraceptive method.[1,2] This global number obscures substantial geographical differences; 73% of women with unmet need live in the world’s poorest countries, with the majority living in Asia and sub-Saharan Africa
In Chad, we provided family planning services to 46,571 new users, for an average of 862 new users per month, reaching 34% of the eligible population
Our analysis contributes to this discussion by describing trends in method mix over time in 2 countries—Chad and Democratic Republic of the Congo (DRC)—where we implemented a focused set of interventions to improve access to and use of modern contraception, especially effective, long-acting reversible methods
Summary
That there are 225 million women who want to avoid pregnancy but are not currently using a contraceptive method.[1,2] This global number obscures substantial geographical differences; 73% of women with unmet need live in the world’s poorest countries, with the majority living in Asia and sub-Saharan Africa. The proportion of women with unmet need in Central and Global Health: Science and Practice 2016 | Volume 4 | Supplement 2
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